Guías Latinoamericanas de Infecciones Congénitas y Perinatales de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE). Parte II / Latin American Guidelines on Congenital and Perinatal Infections from the Latin-American Society of Pediatric Infectious Diseases (SLIPE). Part II

Las infecciones perinatales son una causa de morbilidad, tanto fetal como neonatal, y que compromete la salud de la mujer embarazada, por lo que su diagnóstico, tratamiento, e intento de eliminación son una prioridad en América Latina y el Caribe. Este documento representa la segunda entrega realizada por expertos en la región dentro de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE), brindando una mirada actualizada en el manejo de las infecciones congénitas y entrega herramientas para detectar posibles momentos estratégicos de intervención y cambio en el manejo de las infecciones congénitas.

Perinatal infections are a major cause of morbidity and mortality in the fetus, neonate, and the health of the pregnant woman. Diagnosis, treatment, and the search for elimination of these diseases are a priority in Latin America and the Caribbean. This document represents the second delivery by a group of experts in the region inside the Latin-American Society of Pediatric Infectious Diseases (SLIPE), presenting a up-to-date look into the management of congenital infectious diseases and give a tool to detect possible strategic sceneries and a change in the management of congenital infections in our region.

Dengue en el primer año de la vida / Dengue in the first year of life

Introducción: El dengue es considerada la más importante de todas las arbovirosis por su gran carga de enfermedad e implicaciones sociales. Es una enfermedad infecciosa causada por cualquiera de los cuatro serotipos del complejo dengue, que se trasmite al hombre a través de la picada de un mosquito del género Aedes. Objetivo: Caracterizar las manifestaciones clínicas en lactantes con dengue confirmado. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo de las manifestaciones clínicas de150 lactantes con diagnóstico de dengue confirmado por serología que fueron hospitalizados en el Hospital Materno Infantil Dr. Ángel Arturo Aballí en el período de julio- septiembre del año 2014. Resultados: Los lactantes entre 7 y 12 meses de edad fueron los más afectados (66,8 por ciento), con predominio del sexo femenino (54,0 por ciento). Las principales manifestaciones clínicas fueron: fiebre, manifestaciones respiratorias altas y exantema. La aparición de los signos de alarma coincidió con la defervescencia de la fiebre en 14 niños (9,3 por ciento) y los vómitos frecuentes y la letargia o irritabilidad fueron los síntomas más reiterados. Un solo paciente (0,7 por ciento) presentó cuadro clínico de choque. Conclusiones: Durante el primer año de vida, la enfermedad dengue puede presentarse de modo particular y semejar cualquier otra infección viral. El criterio epidemiológico tiene suma importancia, así como la presencia de fiebre, exantema y las manifestaciones respiratorias que no siempre se asocian al dengue en otras edades(AU)

Introduction: Dengue is considered the most important of all arboviruses because of its high burden of disease and social implications. It is an infectious disease caused by any of the four serotypes of the dengue complex, which is transmitted to the human beings through the bite of a mosquito of Aedes genus. Objective: Characterize the clinical manifestations in infants with confirmed dengue. Methods: An observational, descriptive and retrospective study of the clinical manifestations of 150 infants with a diagnosis of dengue confirmed by serology who were hospitalized at Dr. Ángel Arturo Aballí Mother and Child Hospital in the period July-September 2014 was conducted. Results: Infants between 7 and 12 months of age were the most affected (66.8 percent), with a predominance of females (54.0 percent). The main clinical manifestations were: fever, upper respiratory tract manifestations and rash. The appearance of the warning signs coincided with the defervescence of fever in 14 children (9.3 percent) and frequent vomiting and lethargy or irritability were the most repeated symptoms. Just one patient (0.7 percent) presented a clinical picture of shock. Conclusions: During the first year of life, dengue disease can occur in a particular way and resemble any other viral infection. The epidemiological criterion is extremely important, as well as the presence of fever, rash and respiratory manifestations that are not always associated with dengue at other ages(AU)

Tropical Infections in the Context of Kidney Transplantation in Latin America.

Reports on tropical infections among kidney transplant (KT) recipients have increased in recent years, mainly because of the growing number of KT programs located in tropical and subtropical areas, and greater mobility or migration between different areas of the world. Endemic in emerging and developing regions, like most countries in Latin America, tropical infections are an important cause of morbidity and mortality in this population. Tropical infections in KT recipients may exhibit different pathways for acquisition compared with those in nonrecipients, such as transmission through a graft and reactivation of a latent infection triggered by immunosuppression. Clinical presentation may differ compared with that in immunocompetent patients, and there are also particularities in diagnostic aspects, treatment, and prognosis. KT patients must be screened for latent infections and immunized properly. Last, drug-drug interactions between immunosuppressive agents and drugs used to treat tropical infections are an additional challenge in KT patients. In this review, we summarize the management of tropical infections in KT patients.

Nanotechnology as a tool for detection and treatment of arbovirus infections.

Arboviruses are medically important viruses that cause high rates of infection all over the world. In addition, the severity of the symptoms and the inadequate diagnostic methods represent a challenge far beyond eradicating the vector. The lack of specific treatments for arbovirus infections reflects the imminent need for new research for safe and efficient medicines to treat these infections. Nanotechnology is an innovative approach currently used as a platform for developing new treatments, thus improving the biopharmaceutical properties of drugs. It can also be applied to the development of diagnostic devices, improving their detection capacity. The purpose of this paper is to review recent research on the use of nanotechnology for developing new treatments and detection devices for arbovirus infections. Interestingly, it was found that only a few studies report on the use of nanotechnology to treat arbovirus infections and that most of these reports focus on the fabrication of diagnostic tools. Also, some papers report on the use of nanotechnology for the development of vaccines, which in association with mosquito eradication programs could effectively reduce the high rates of infections by these viruses.

Vigilancia epidemiológica intensificada de arbovirosis: primer caso de dengue autóctono en Cataluña (España), zona Metropolitana Norte de Barcelona, 2018-2019 / Intensified epidemiological surveillance of arbovirosis: First case of native dengue fever in Catalonia (Spain), Northern Metropolitan Area of Barcelona, 2018-2019

OBJETIVO: Valorar los resultados obtenidos por una red de vigilancia epidemiológica y asistencial de arbovirosis compuesta por médicos y profesionales de enfermería de hospital y atención primaria (AP) formados en su identificación, confirmación diagnóstica y manejo clínico. Emplazamiento: Zona Sanitaria Metropolitana Norte de Barcelona (1.400.000 habitantes; Cataluña, España) durante un año natural. PARTICIPANTES: Diecisiete médicos (7 de AP y 10 hospitalarios) más 4 enfermeros/as de AP. Tipo de estudio: Estudio observacional prospectivo. Mediciones principales: Se definieron variables demográficas, epidemiológicas (caso autóctono/importado, sospechoso/probable/confirmado) y asistenciales (síntomas, perfil serológico, periodo virémico). RESULTADOS: De los 34 pacientes identificados cumplían criterios de estudio 26 (76,5%) casos; de ellos, se confirmó alguna arbovirosis en 14 (53,8%): 13 fiebres dengues más 1 chikungunya. No se registraron casos de fiebre de zika. Existían antecedentes de viaje a zonas endémicas (23; 88,4%), pero no en 3 casos (11,6%), en los que se consideró la posibilidad de una transmisión autóctona; de ellos, se confirmó un caso de dengue. La incidencia estimada de arbovirosis fue de 0,4 (IC 95%: 0,33-0,51) casos × 10.000 hab./año, que, comparada con la incidencia estimada en la misma área geográfica durante el periodo 2009-2013 (0,19 casos ×10.000hab./año; IC 95%: 0,07-0,31), mostró un incremento significativo (p = 0,044). Los pacientes en periodo de viremia al momento de la primera visita médica fueron 11 (42,3%). CONCLUSIONES: Un programa de vigilancia epidemiológica intensificada definido a nivel de AP y hospitalario es capaz de detectar significativamente más casos de arbovirosis importadas y transmitidas autóctonamente. Posiblemente asistimos a un aumento en la incidencia de arbovirosis importadas, por lo que las medidas encaminadas a su identificación y confirmación deben reforzarse

OBJECTIVE: To evaluate the results obtained by a surveillance network on arbovirosis composed by doctors and nurses located at hospitals and Primary Care trained in their identification, diagnostic confirmation and clinical management. LOCATION: North Metropolitan Area of Barcelona (1,400,000 inhabitants; Catalonia; Spain) during a calendar year. PARTICIPANTS: Seven Primary Care and 10 hospital physicians plus 4 Primary Care nurses. Type of study: A prospective observational study. MAIN MEASUREMENTS: Demographic, epidemiological (autochthonous/imported, suspect/probable/confirmed case) and healthcare variables (symptoms, serological profile, viral period) were defined. RESULTS: Of the 34 patients identified, 26 (76.5%) met study criteria. Among them, any arbovirosis was confirmed in 14 (53.8%): 13 dengue plus 1 chikungunya fever. There were no cases of Zika fever. There was a history of travel to endemic areas 23 (88.4%), but not in 3 cases (11.6%) in which the possibility of an indigenous transmission was considered; of them, a case of dengue was confirmed. The estimated incidence of arbovirosis was 0.4 (95% CI: 0.33-0.51) cases × 10,000 hab/year which, when compared to the estimated incidence in the same geographical area during the period 2009-2013 (0.19 cases × 10,000 hab/year; 95% CI: 0.07-0.31), a significant increase was found (P = .044). Patients within viremia period at the time of their first medical visit were 11 (42.3%). CONCLUSIONS: An intensified epidemiological surveillance program defined at Primary Care and hospital levels is able to detect significantly more cases of imported and autochthonous arbovirosis. Possibly we are witnessing an increase in the incidence of imported arbovirosis and, thus, measures aimed at their identification and confirmation should be reinforced

Severity Index for Suspected Arbovirus (SISA): Machine learning for accurate prediction of hospitalization in subjects suspected of arboviral infection.

BACKGROUND: Dengue, chikungunya, and Zika are arboviruses of major global health concern. Decisions regarding the clinical management of suspected arboviral infection are challenging in resource-limited settings, particularly when deciding on patient hospitalization. The objective of this study was to determine if hospitalization of individuals with suspected arboviral infections could be predicted using subject intake data. METHODOLOGY/PRINCIPAL FINDINGS: Two prediction models were developed using data from a surveillance study in Machala, a city in southern coastal Ecuador with a high burden of arboviral infections. Data were obtained from subjects who presented at sentinel medical centers with suspected arboviral infection (November 2013 to September 2017). The first prediction model-called the Severity Index for Suspected Arbovirus (SISA)-used only demographic and symptom data. The second prediction model-called the Severity Index for Suspected Arbovirus with Laboratory (SISAL)-incorporated laboratory data. These models were selected by comparing the prediction ability of seven machine learning algorithms; the area under the receiver operating characteristic curve from the prediction of a test dataset was used to select the final algorithm for each model. After eliminating those with missing data, the SISA dataset had 534 subjects, and the SISAL dataset had 98 subjects. For SISA, the best prediction algorithm was the generalized boosting model, with an AUC of 0.91. For SISAL, the best prediction algorithm was the elastic net with an AUC of 0.94. A sensitivity analysis revealed that SISA and SISAL are not directly comparable to one another. CONCLUSIONS/SIGNIFICANCE: Both SISA and SISAL were able to predict arbovirus hospitalization with a high degree of accuracy in our dataset. These algorithms will need to be tested and validated on new data from future patients. Machine learning is a powerful prediction tool and provides an excellent option for new management tools and clinical assessment of arboviral infection.

Mosquito population control strategies for fighting against arboviruses.

In the fight against vector-borne arboviruses, an important strategy of control of epidemic consists in controlling the population of the vector, Aedes mosquitoes in this case. Among possible actions, two techniques consist either in releasing sterile mosquitoes to reduce the size of the population (Sterile Insect Technique) or in replacing the wild population by one carrying a bacteria, called Wolbachia, blocking the transmission of viruses from insects to humans. This article addresses the issue of optimizing the dissemination protocol for each of these strategies, in order to get as close as possible to these objectives. Starting from a mathematical model describing population dynamics, we study the control problem and introduce the cost function standing for population replacement and sterile insect technique. Then, we establish some properties of the optimal control and illustrate them with numerical simulations.

Five Emerging Neuroinvasive Arboviral Diseases: Cache Valley, Eastern Equine Encephalitis, Jamestown Canyon, Powassan, and Usutu.

There are many arthropod-borne viruses (arboviruses) capable of neuroinvasion, with West Nile virus being one of the most well known. In this review, we highlight five rarer emerging or reemerging arboviruses capable of neuroinvasion: Cache Valley, eastern equine encephalitis, Jamestown Canyon, Powassan, and Usutu viruses. Cache Valley and Jamestown Canyon viruses likely circulate throughout most of North America, while eastern equine encephalitis and Powassan viruses typically circulate in the eastern half. Usutu virus is not currently circulating in North America, but has the potential to be introduced in the future given similar climate, vectors, and host species to Europe (where it has been circulating). Health care providers should contact their state or local health departments with any questions regarding arboviral disease surveillance, diagnosis, treatment, or prevention. To prevent neuroinvasive arboviral diseases, use of insect repellent and other mosquito and tick bite prevention strategies are key.

Situação das arboviroses em Pernambuco destaque Chikungunya

Emerging arboviruses and implications for pediatric transplantation: A review.

Recent years have brought a rise in newly emergent viral infections, primarily in the form of previously known arthropod-transmitted viruses that have increased significantly in both incidence and geographical range. Of particular note are DENV, CHIKV, and ZIKV, which are transmitted mostly by Aedes species of mosquitoes that exhibit a wide and increasing global distribution. Being important pathogens for the general population, these viruses have the potential to be devastating in the international transplant community, with graft rejection and death as possible outcomes of infection. In this review, we discuss the current state of knowledge for these viruses as well as repercussions of infection in the solid organ and HSCT population, with a focus, when possible, on pediatric patients.

The re-emerging arboviral threat: Hidden enemies: The emergence of obscure arboviral diseases, and the potential use of Wolbachia in their control.

Mayaro, Oropouche, and O'Nyong-Nyong share many traits with more prominent arboviruses, like dengue and yellow fever, chikungunya, and Zika. These include severe clinical symptoms, multiple animal hosts, and widespread vector species living in close proximity to human habitats, all of which constitute significant risk factors for more frequent outbreaks in the future, greatly increasing the potential of these hidden enemies to follow Zika and become the next wave of global arboviral threats. Critically, the current dearth of knowledge on these arboviruses might impede the success of future control efforts, including the potential application of Wolbachia pipientis. This bacterium inherently possesses broad anti-pathogen properties and a means of genetic drive that allows it to eliminate or replace target vector populations. We conclude that control of obscure arboviruses with Wolbachia might be possible, but successful implementation will be critically dependent on the ability to transinfect key vector species.

[Emerging arboviruses]. / Arboviroses émergentes: quelle démarche diagnostique chez les voyageurs?

Many arthropod-borne viruses (arboviruses) underwent a dramatic geographic expansion over the last few years, following the spread of their vectors. It is the case for dengue, currently endemic in most tropical regions, for chikungunya and Zika viruses, which propagated rapidly over a considerable territory. West Nile is one of the most broadly distributed arboviruses in the world. The clinical presentation of these viral infections is non-specific (fever, arthralgia, headache, rash). For travelers presenting with fever within 15 days after returning from an endemic area, laboratory tests can distinguish them. The management is essentially supportive but a specific diagnosis might be important in anticipating possible complications and in decreasing the number of laboratory tests often offered in the case of fever of unknown origin.

Infections of the developing world.

Access to critical care is rapidly growing in areas of the world where it was previously nonexistent and where infectious diseases often comprise the largest disease burden. Additionally, with crowding, mass migrations, and air travel, infectious diseases previously geographically confined are quickly spread across the planet, often in shorter time frames than disease incubation periods. Hence, critical care practitioners must be familiar with infectious diseases previously confined to the developing world. This article reviews selected tropical diseases that are seen in diverse locales and often require critical care services.

[Immunotropic therapy of arbovirus infections in children].

Cytochemical indices of peripheral blood leukocytes were investigated. The results allowed to estimate the level of the disease severity and to control the immunotropic therapy efficacy. Dysbalance of the interleukocytic microbicidical systems (IMS) of neutrophils reflected the nonspecific resisistance and the state of the phagocytic system as an objective criterion of the adaptation syndrome. Association of the deficiency of the IMS components and blood serum fibronectin were considered as a predisposition of bacterial complications. Cycloferon activated the phagocyte metabolic activity and promoted elimination of the main clinical symptoms of the disease (acute infective damage of the meninges, temperature elevation, intoxication signs), thus making shorter the hospitalization terms.

Neglected infections of poverty in Texas and the rest of the United States: management and treatment options.

In the poorest regions of the United States, especially along the Gulf Coast and in South Texas, are a group of endemic parasitic and related infections known as the neglected infections of poverty. Such infections are characterized by their chronicity, disabling features, and disproportionate impact on the estimated 46 million people who live below the U.S. poverty line. Today more Americans live in poverty than ever before in the half-century that the Census Bureau has been recording poverty rates. In association with that poverty, a group of major neglected infections of poverty have emerged in the United States. Here we describe the major neglected infections of poverty in the United States, with a brief overview of their significant epidemiological features, their links with poverty, and our approaches to their diagnosis, management, and treatment.